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What you should know about multiple myeloma

Recent news about the health of the distinguished journalist, Tom Brokaw, has focused attention on multiple myeloma, a malignant disease of the bone marrow. Myeloma is characterized by an uncontrolled growth of marrow plasma cells, which normally produce antibodies for our immune system. In its advanced stages, the overgrowth of these cells and their associated proteins can cause anemia, painful bone destruction, and kidney failure.
 
Until about 10 years ago, advanced myeloma was uniformly fatal with a typical survival of about 3 years. Recent years, however, have seen a remarkable improvement in treatment possibilities for myeloma. This began with the discovery that autologous stem cell transplantation could produce complete remissions and longer survival. In addition, a variety of chemotherapy drugs administered in combination with corticosteroid drugs, now produce responses in up to 80% of patients. This means about 80% of patients are surviving longer than 3 years after chemotherapy and autologous stem cell transplant.
 
Not all patients with myeloma require chemotherapy. Myeloma can exist in an early stage for years. This is called smoldering myeloma. Chromosome analysis is routinely done on myeloma cells and allows us to identify patients with more aggressive forms of the disease, and those requiring treatment due to signs of organ damage or bone pain.
 
The Swedish Cancer Institute has been a participant in clinical trials leading to the development of some of the effective new treatments for myeloma. We are currently participating in a study of pomalidomide, a newly approved agent, for patients with relapsed myeloma. Another study offers an investigational drug, MLN9708, for newly diagnosed patients.
 
While the new drugs are more effective and better tolerated than previous chemotherapy, all  ...

Pivotal time for chronic hepatitis C treatment

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.*  Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes.  They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider.  In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965.  Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects.  Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year. 

However, this is a pivotal time for hepatitis C patients because treatment has improved by leaps and bounds.  In late 2013, two ...

Breast Cancer Survival Guide: Physical & Clinical Updates

A diagnosis of breast cancer sets into motion a whirlwind of appointments, tests, surgeries and possibly chemotherapy and radiation treatment. A new study reviewed the timeline between surgery and initiating chemotherapy for different subtypes of breast cancer and found a survival advantage when chemotherapy was initiated within 30 days of surgery. Although treating within the 30-60 post-surgical window did not show a statistically significant survival advantage, there is a trend towards better outcomes. Exceeding 60 days post treatment had a negative impact on survival. The clinical impact of timing is most relevant for patients with stage II and III breast cancer, triple negative breast cancer and HER2-positive tumors.
 
Treatment for breast cancer can be exhausting and take a toll on the physical health of patients as treatment ends and they begin post-treatment life. Cancer survivors are at an increased risk of poor health, depression and physical disability. Approximately one third  ...

Living with achalasia like Seahawk Malcolm Smith

On February 3, 2014, Yahoo Sports published an article regarding this years’ Super Bowl MVP, Malcolm Smith, as not only achieving recognition for his Super Bowl performance, but also dealing with a rare swallowing disorder known as achalasia.
 
Achalasia is a rare disorder with a prevalence of 10 cases per 100,000 individuals.  Men and women are equally affected and it is usually diagnosed between the ages of 25 to 60 years.  The disease often comes on slowly and is gradually progressive with problems swallowing solids and liquids, and movement of undigested food particles back up into the mouth unintentionally (bland regurgitation).  Patients also often complain of a burning chest sensation. Other symptoms include hiccups, difficulties belching, and sometimes weight loss.

The condition can be seen with radiology studies including a barium esophagram that shows a dilated, or larger than normal, caliber of the esophagus with a narrowing or tightness at the lower esophageal sphincter. The lower esophageal sphincter is located at the end of the esophagus before it enters the stomach.  An upper endoscopy or camera study is often performed to evaluate the esophagus and stomach closely.  It is ultimately diagnosed with high-resolution esophageal manometry, which is a technique for evaluating esophageal motor dysfunction or movement disorders of the esophagus.

Once achalasia is diagnosed, there are different treatment options ...

Jaundice in newborn babies

As a new parent, you’re understandably eager and excited to leave the hospital and settle into your new routine with your baby. Sometimes, that routine is delayed due to the baby’s blood test confirming hyperbilirubinemia, also known as jaundice.

Jaundice in newborns is caused by an excess of red blood cells. Jaundice is seen as a yellow color to the skin, appearing first at the head (skin and sclera – or “whites of the eyes”) then progressing to the feet. As it decreases, it lessens in reverse. Before birth, the placenta removes bilirubin from the baby’s system; after birth, the baby’s liver takes over. In breast-fed babies, an imbalance between mother’s milk supply and baby’s feeding can lead to a higher-than-expected bili level. In addition to ensuring the baby is feeding well and having enough wet/stool diapers, phototherapy or “bili lights” may be needed. Bili lights help speed up the process by breaking down the bilirubin in the skin.

For phototherapy, your baby will be ...

Cyberknife for spine patients

Cyberknife is a type of radiosurgery used to deliver radiation to a specific part of the body.  This high-energy x-ray system utilizes a robotic arm to deliver focused beam radiation.  While the focused radiation can destroy tumor cells and halt tumor growth, the surrounding tissues have minimal exposure to the radiation, thus sparing them from damage.

When is it used?

CyberKnife is useful for both cancerous and noncancerous tumors.  While it has been used to treat tumors of the head, neck, breast, lung, pancreas, kidney, liver, and prostate, it can be extremely effective for the treatment of  spinal tumors.  

How does CyberKnife work?

Patients who undergo CyberKnife have a specialized treatment plan created for them by their neurosurgeon, radiation oncologist, and a medical physicist.  These personalized plans take into account the specific location of the tumor in the body, including the tumor type, shape, size, surrounding tissues and organs (to minimize radiation exposure) and the exact quantity of radiation the tumor cells are receiving,

Why not just have surgery?

Any ....

Troubles swallowing food or liquids – what does it mean?

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach.  This abnormality is increasingly recognized as an important concern that requires attention and study.  There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement.  There are also two major anatomical sites, oropharyngeal and esophageal. 
 
Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus.  This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region.  A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study.  This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing.  Most ...
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